Policies Sought On Elder Voters

Dementia Study Backs Guidelines

Jacqueline Levesque, in the early stages of Alzheimer's disease, no longer drives. She is unable to sign her name.

But last week, assisted by a poll worker, she cast her ballot for president.

"You could tell she was afraid they would tell her no, she couldn't vote," said daughter Joceline Braddock of Lake Worth, who accompanied her 79-year-old mother to an early voting location. Braddock's husband, John, 57, has dementia from a work-related brain injury; he voted, too, several days later, with his wife's help.

It's impossible to tell how many voters with dementias such as Alzheimer's will cast ballots in this election. But one thing appears certain: Their numbers are increasing and will continue to grow, as Americans live longer and the Baby Boomers age. Talking to 101 Alzheimer's patients and their caregivers immediately after the 2000 election, researchers at Brown University found 60 percent of them had voted.

There are an estimated 4.5 million people nationwide with the disease, projected to grow to 15 million by 2050. Florida -- a key swing state in this and the last presidential race -- is home to 400,000, according to the national Alzheimer's Association.

But are all of them qualified to vote? If not, at what point do they lose a Constitutional right? How is this potentially vulnerable group protected from being improperly influenced or defrauded when making their choices?

These questions, often unanswered in state election law, are getting a lot of attention now. The election is expected to be close, every ballot counts, and senior citizens in general have the highest turnout rates.

"This is a potential voting block that has been ignored, which deserves some accommodations to exercise a fundamental right," said Charles Sabatino, the assistant director of the American Bar Association's Commission on Law and Aging.

Sabatino is part of the Dementia Voters Project, created at the University of Pennsylvania's Alzheimer's Disease Center last year and the first to take a comprehensive look at the issue.

While much has been done to make polling places and the voting process accessible to those with physical disabilities, Dr. Jason Karlawish thinks the same should go for those with cognitive impairments.

"Forget the giggle factor. [Alzheimer's patients] are out there and they deserve to have their rights respected," said Karlawish, an assistant professor at Pennsylvania's medical school and a project founder.

Yet even those who care and advocate for Alzheimer's patients feel conflicted when it comes to voting.

At the deHoernle Alzheimer's Pavilion in Deerfield Beach, one of the 42 residents calls Executive Director Barry Solomon "Mr. President." Another thinks he is her parish priest.

"These people are fairly advanced in their dementia, and I'm not sure if any of them would understand what an election is," Solomon said. County records show no voters registered at the pavilion's address. Solomon has no idea if any are casting absentee ballots obtained by families.

Like other Floridians, Solomon has watched as relatives or nursing aides take the hands of very elderly voters as they step toward the voting machine, and he has wondered about the line between assistance and influence. Solomon also feels guilty he has never raised the issue of voting with residents and families. "Should I explore it? Probably. But I'm not sure how I would even do it," he said.

Just as there now are materials that help families and doctors assess an Alzheimer's patient's ability to drive safely, those with the Dementia Voters Project think there should be similar guidelines for voting. Other recommendations outlined in a paper published by Karlawish and eight others in the Sept. 15 Journal of the American Medical Association include creating uniform policies on how to conduct voting in long-term care facilities, guarding against fraud. And states need to adopt or update mental competency laws in regards to voting, the paper said.

Florida is one of eight states where people who have been found mentally incompetent by the courts can lose their voting rights. Yet none of those states has a test designed to gauge voting ability.

The project is drafting a simple tool that might be used in guardianship hearings and other situations. The focus is on a patient's ability to make a choice and understand what an election is, not current events. One question, for example, is "How is it decided which candidate wins?"

But Steve Gey, a constitutional law professor at Florida State University, sees challenges in applying the test in nursing homes or at the ballot box. "Are they going to deny you the right to vote if you answer the question wrong?" he asked.